| NPI | 1255822904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 10755) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI Q498793) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024005) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-02-21 |